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my Blue Access WV PPO Gold 0 + Adult Dental and Vision

Highmark Blue Cross Blue Shield West Virginia

Starting at

$935

/month before subsidy

Key facts

my Blue Access WV PPO Gold 0 + Adult Dental and Vision is a 2026 Gold PPO health insurance plan from Highmark Blue Cross Blue Shield West Virginia, sold on the ACA Marketplace in West Virginia under plan ID 31274WV0570003. The monthly premium starts at $935 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $0, and the individual out-of-pocket maximum is $7,500 ($15,000 for a family). After the deductible, coinsurance is 30% for covered in-network care. The plan is not HSA-eligible.

Plan ID: 31274WV0570003
Plan year: 2026
State: West Virginia
Metal level: Gold
Plan type: PPO
HSA-eligible: No

Individual Deductible

Family: $0

Out-of-Pocket Max

$7,500

Family: $15,000

Coinsurance

30%

You pay after deductible

Network Type

PPO

WVN001

Cost Sharing

What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$20.00

Specialist Visit$20.00

Urgent Care$40.00

Emergency Room$400.00

Prescription Drugs

Generic DrugsNo Charge

Brand Name Drugs$150.00

Specialty Drugs50.00%

CMS Quality Rating

The federal government's star rating for this plan, based on clinical data and member surveys — the same rating shown on HealthCare.gov.

3.0overall

Medical care
Member experience: Not rated
Plan administration

What you'd typically pay

Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$1,260

your estimated cost

Deductible: $0
Copays: $1,200
Coinsurance: $0

Managing type 2 diabetes

A year of routine care

$920

your estimated cost

Deductible: $0
Copays: $700
Coinsurance: $200

A simple fracture

ER visit + follow-up

$1,000

your estimated cost

Deductible: $0
Copays: $600
Coinsurance: $400

Is your medication or doctor covered?

Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.

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Official Plan Documents

Published by Highmark Blue Cross Blue Shield West Virginia. These are the authoritative source for coverage details.

Summary of Benefits & Coverage (SBC)Standardized cost & coverage summary Plan BrochureFull plan details from the insurer Drug FormularyCovered prescriptions & drug tiers

Who This Plan Is Best For

This Gold PPO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.

Consider this plan if you:

Have ongoing health conditions requiring regular care
Take multiple prescription medications
Prefer lower costs at the time of service
Want peace of mind with comprehensive coverage

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost

What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,560/month

Annual Premium

$11,220

OOP Maximum

$7,500

💡 What this means:

With a $0 deductible, you pay 100% of costs until you've spent that much. After that, you pay 30% (coinsurance) until you hit $7,500 total. Then insurance covers everything else for the year.

More plans from Highmark Blue Cross Blue Shield West Virginia in West Virginia

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Frequently asked questions about my Blue Access WV PPO Gold 0 + Adult Dental and Vision

How much does my Blue Access WV PPO Gold 0 + Adult Dental and Vision cost per month?

my Blue Access WV PPO Gold 0 + Adult Dental and Vision from Highmark Blue Cross Blue Shield West Virginia starts at $935 per month before any subsidy in West Virginia. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for my Blue Access WV PPO Gold 0 + Adult Dental and Vision?

The individual medical deductible is $0. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for my Blue Access WV PPO Gold 0 + Adult Dental and Vision?

The most you would pay in a year for covered in-network care is $7,500 for an individual and $15,000 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is my Blue Access WV PPO Gold 0 + Adult Dental and Vision HSA-eligible?

No. my Blue Access WV PPO Gold 0 + Adult Dental and Vision is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.

What type of network does my Blue Access WV PPO Gold 0 + Adult Dental and Vision use?

my Blue Access WV PPO Gold 0 + Adult Dental and Vision is a PPO plan. PPO plans let you see specialists without a referral and use out-of-network providers (at higher cost), offering the most flexibility.

Understand what you'd actually pay

2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
How ACA subsidies work
Premium tax credits and who qualifies
The 2026 subsidy cliff
Why income near 400% FPL matters again this year

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Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.